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Infectious Disease Epi > MPox and Respiratory Syncytial Virus, Human Metaneumovirus > Flashcards

MPox and Respiratory Syncytial Virus, Human Metaneumovirus Flashcards

1
Q

In 2022, what happened to the mPOX cases?

A

They began to increase

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2
Q

What were the symptoms of the case of mPOX?

A

-38 year old male with well controlled HIV on ARV
-rectal pain that started abt 5 days after condomless recetive anal sex
- endorses tensmus, pain with defecation
-recent traval
-development of itchy rash
no rever

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3
Q

What was the approach for this case of mPOX?

A

Differential: HSV, treponema pallidum,
- rash was swabbed and sent in viral transport media
-positive for monkeypox DNA

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4
Q

What is the background of Mpox?

A

Orthopoxvirus (Family-Poxviridae)
- large DNA viruses
-immunological cross-reactivity and cross-protection with Variola
-infection with any member of the genus confers some protection with any other members of the same genus
- decrease in herd immunity since cessation of widespread smallpox vaccination

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5
Q

What does it mean that it is a rare, zoonotic infection?

A

definitive animal resevoiir unknown
small mammal/rodent suspected

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6
Q

When were the two major outbreaks for Monkeypox?

A

2003 Outbreak
- linked to prarie dogs housed with gambian pouched rats

2022 Outbreak
- west african clade - lower mortality
gay bisexual men

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7
Q

In the US, ______ are common among people with monkeypox

A

HIV or recent STIs

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8
Q

It is important to consider this for Mpox?

A
  1. Prioritize people with HIV and STis for monkeypox vaccination
  2. Offer HIV and STI screening for people evalutated for monkeypox
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9
Q

How does Mpox spread?

A

close skin to skin contact
- intimate contact
- cuddling/kissing
-contact with secretions from another infectious indiviudals

  • fomites
    -bite/scratch from an infected anima
  • vertical
    -droplet
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10
Q

What was the risk of proctitis due to human mpox?

A

5.5 times higher among those who recently engaged in anal intercourse
95% of patients that presented with tonsilitis reported receptive oral intercourse

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11
Q

How long can Mpox persist on surfaces?

A

live virus 15 days after a patient’s to a household

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12
Q

Are asymptomatic cases of monkeypox possible?

A

with 224 stored samples, 3 tested positive for MonkeyPox

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13
Q

What are some signs and symptoms of monkeypox?

A

-Classic lesions:
- firm, deep-seated, well circumscribed, painful, itchy sometimes umbilicated

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14
Q

What is a classic presentation?

A

Incubation from 5-21 days
Initally: prodromal symptoms
Characteristic rash: starts in the mouth, and then spreads to the face and extremeties

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15
Q

What are the current outbreak: atypical features?

A

still characteristic firm-like lesions, but often starting in
-sometimes not disseminating elsewhere
Prodromal symptoms: mild, not occuring, occuring after rash

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16
Q

When are the rashes no longer infectious?

A

until the lesions form scabs and they fall off

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17
Q

What is testing for monkeypox virus like?

A

single swab or multiple lesions for monkeypox virus PCR testing is the preferred method for diagnosis
-specimen collection can be performed at any site that has viral transport medial available
PPE is required

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18
Q

What are the two vaccines and what are their qualities?

A

ACAM2000
(higher risk) and JYNNEOS (lower risk)

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19
Q

What are vaccine strategies to prevent monkeypox?

A

Post exposure prophylaxis
- within 4 days from the date of exposure for the best change to prevent disease
-vaccination may reduce the symptoms

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19
Q

What is expanded post exposure prophylaxis?

A

people with certain risk factors are more likely to have been recently exposed to monkeypox

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19
Q

What is vaccine eligibility like in allegheny county?

A
  • physical contact to someone diagnosed with monkeypox
    -had a sex partner in the past 2 weeks who has symptoms of monkeypox
    -participated in activities where multiple cases of monkeypox occured
    -exchanged sex for money or goods
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20
Q

What is prior vaccine evidence like?

A

-study in the 1980s in the democratic republic of congo called zaire
-virus jumps from animal to people
-secondary attack rates - smallpox vaccine was 86% effectuve

21
Q

What were the limitation of the vaccine protection?

A

small number of cases, the virus genetically different than the one now spreading, different vaccine

22
Q

What was the vaccine efficacy for MPOx?

A

incidence among unvaccinated persons was 7.4 and 9.6 times along persons who received dose 2>14 days earlier

23
Q

What is the difference between the interadermal and subcutaneous dosing?

A

No difference

24
Q

What is the CDC interim clinical guidance for the treatment of monkeypox?

A
  • severe disease (hemorrhagic disease, confluent lesions, sepsis, encephalitis, conditions requiring hospitalization
  • aberrant infections
  • high risk of severe disease
  • immunocompromised
    -pediatric
  • atopic dermatitis
25
Q

TPOXX

A

inhibitor of Vp37 envelope wrapping protein

26
Q

Why is a study necessary?

A

we don’t know if Tpoxx is effective against Mpox
-current practice based on studies of smallpox
-optimal dosing - especially in children
-resistance

27
Q

What is preventing stigma like?

A

promote messaging that provides information on what monkeypox is and how it can spread and encourages seeking health care if experiencing monkeypox-like symptoms

28
Q

What are the MPX case rates among Black people vs. white?

A

cases are five times of those over white people

29
Q

WHen was the Chicago Outbreak of MPOX?

A

March 18-June 12, 2023 40 laboratory-confirmed mpox were identified?

30
Q

What are the successes of MPOX vaccine?

A

testing capability expanded rapidly allowing for surveillance, rapid diagnosis/isolation/treatment
-pre-exisiting Mpox vaccine mobilized and prioritized for communities
- intradermal dosing allowed for greater supply

31
Q

What were the lessons learned?

A

importance of nimble, tailored response to provide testing, prevention, treatment to communitieis at risk
- stigmatization may change behavior to an extent

32
Q

Reemergent zoonosis with atypical _______

A

clinical presentation and epidemiology

33
Q

What type of contact is mPOX from?

A

transmission largely close contact

34
Q

What vaccine is safe and prioritized for affected populations?

A

Jynneos

35
Q

What are viruses blind to?

A

gender identity, sexual orientation, race/ethnicity but stigmatization and fear can perpetuate disparities, limit access to testing and care, and can promote further transmission

36
Q

How may the virus re-emerge?

A

in the future underscoring the importance of strong public leadership, infrastucture, and preparedness

37
Q

What is the leading cause of death worldwide?

A

lower respiratory infection

38
Q

What is the leading cause of child hospitalization?

A

respiratory disease

39
Q

What are the most common pathogens in children hospitalized with pneumonia?

A

viruses

40
Q

What are paramyoxovirus?

A

parainfluenza virus 1-4
-measles virus
-mumps
-nipah

41
Q

What are pneumoviruses?

A

respiratory syncytial vrius
- human metaneumovirus

42
Q

What is the #1 serious virus in children?

A

RSV
- all children infection by age 2
- severe disease <6 months of comorbities

43
Q

RSV epi overview

A

75% of infants infected by 12 months
- transmitted by respiratory droplets
- high attack rate in contacts

44
Q

RSV clinical disease

A
  • upper respiratory illness
  • lower respiratory illness (LRI) in infants: pneumonia, bronchiolitis
    -apnea in very young infants
45
Q

What are the risk factors for severe disease?

A

prematurity, cardiopulmonary disease, smoke, immunocompromised

46
Q

What is the global burden of RSV in children?

A

a. global pnseumonia
b. respiratory synctial virus deaths

47
Q

What is the RSV common in hospitalized adults?

A

11% of hospitalizations for pneumonia
11% for COPD
5% for CHF
7% for asthma

48
Q

What does RSV cause frequently?

A

mucosal reinfection
-short incubation period
-nasal IgA incomplete protection and wanes
- lack of viremia
-antigenic drift
- alternating drifts

49
Q

What is a common cause of lung infection in children?

A

HMPV
-687 children with lung infection

50
Q

How many lung infections?

A

12% of lung infections

51
Q

What does MPV cause in adults?

A

acute respiratory illness
- hospitalized adults 2-11%
-COPD exacerbation 4-12%
-transplant/cancer patients 3-25%
-asthma exacterbation 5-20%
-nursing home outbreaks (many)

52
Q

RSV is common in _____

A

children, severe in infants and old people
- MPV common in kids and adults
- all worse with underlying conditions: premature, asthma, immune compromise, COPD, “frail” elderly

Infectious Disease Epi (4 decks)

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